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General NPI Number Information
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NPI Number | 1891656203
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Entity Type | Organization
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Legal Business Name | MOULTRIE PHARMACY INC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 3690 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6498
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Country | US
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Telephone | 904-794-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 MERRILL RD UNIT 8664
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City | JACKSONVILLE
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State | FL
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Zip | 32239-7728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN JOSEPH DUANE
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Credential |
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Telephone | 904-765-3531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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